The U.S. Preventive Services Task Force reviewed existing research and
concluded that it's unclear whether treating high blood pressure in children
and adolescents controls hypertension long-term or leads to better heart health
in adulthood.

Given the lack of convincing evidence either for or against screening,
the panel has decided not to make any recommendation. However, it is calling
for more research on the benefits and risks of screening.

The task force report, published online Feb. 25 in the journal
Pediatrics, said doctors considering whether to screen or
not should take into account "current scientific research, expert opinion,
their own knowledge and experience, as well their patient's health history
along with the preference of the patient and family."

In the United States, between 1 percent and 5 percent of children and
teenagers have high blood pressure, and among obese youth, the rate is higher —
11 percent, the task force said. The rise in childhood hypertension seen over
the last few decades is probably a result of the obesity epidemic, the task force
added.

In light of this increase, the panel's stance concerns some
doctors.

"I hope pediatricians when they read this don't think because
there is no established direct correlation between screening
for hypertension [in kids] and cardiovascular risk factors in
adulthood that screening doesn't need to be done," said Dr. Ana Paredes,
director of renal research at Miami Children's Hospital in Florida, who had no
part in the report.

"It is extremely important to screen children and adolescents for
hypertension," she said. "That's the official position of the
American Academy of Pediatrics."

The academy also says that if high blood pressure persists, it can
lead to heart failure or stroke in adulthood.

Paredes said she sees many young patients with high blood pressure
today. "We are having an epidemic of hypertension, mainly in preteens and
teenagers, related to overweight and obesity," she said.

However, Paredes doesn't believe most children with high blood
pressure need to take medications to lower their pressure or to reduce
cholesterol.

The first approach involves lifestyle changes, including a healthy
diet and lots of exercise, which usually reduce blood pressure, she
said.

Only a few children with special medical problems would need to take
blood pressure or cholesterol medications, she added.

Task force member Dr. Kirsten Bibbins-Domingo, said, "We are all
concerned about preventing cardiovascular disease, and hypertension in adults
is a very important risk factor that when we treat actually helps prevent
cardiovascular disease."

However, "in children there is not enough solid evidence to
suggest that identifying and treating hypertension in childhood actually helps
in this prevention," she added. "There is not enough solid evidence
to make a recommendation for or against identifying high blood pressure in
childhood and treating it."

Bibbins-Domingo, who is an associate professor of medicine and
epidemiology and biostatistics at the University of California, San Francisco,
said it's up to individual doctors whether or not to screen children and
teens.

Further research is needed to settle the issue, she suggested. This
includes assessing any adverse effects of screening, including labeling and
anxiety, the task force said.

Another expert believes screening children and teens for high blood
pressure is worthwhile even without a lot of data to support it.

"Screening children and adolescents for elevated blood pressure
allows for earlier detection and has the potential to allow effective lifestyle
modification to begin earlier in life," said Dr. Gregg Fonarow, a
spokesman for the American Heart Association and a professor of cardiology at
the University of California, Los Angeles. This could reduce the risk of death
and disability from cardiovascular disease in adulthood, he
explained.

This review did not identify any studies directly evaluating the
effects of blood pressure screening on health outcomes, Fonarow
noted.

"However, a number of studies were identified that showed that
when elevated blood pressure was identified it could be safely and effectively
lowered in children and adolescents," he said.

The task force, an independent group of experts in prevention and
evidence-based medicine working to improve Americans' health, welcomes public
comment on this report until March 25.

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